title: Association of subclinical myocardial injury with arterial stiffness in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  Type 2 diabetes mellitus (T2DM) is associated with subclinical myocardial injury although the underlying mechanism is uncertain. We postulated that arterial stiffness, endothelial dysfunction and subclinical atherosclerosis may contribute to subclinical myocardial injury in patients with T2DM.
  
  
  METHODS
  Serum high-sensitivity troponin I (hs-TNI) an indicator of myocardial injury, was measured in 100 patients with T2DM without clinical evidence of macrovascular disease and 150 age and gender-matched controls. Elevated hs-TnI was defined as follow (derived from the 99th percentile from controls): Male >11.1 ng/L; female >7.6 ng/L. Measures that may contribute to myocardial damage in patients with T2DM, including brachial-ankle pulse wave velocity (ba-PWV), brachial flow mediated dilatation (FMD) and carotid intima media thickness (IMT), were also assessed.
  
  
  RESULTS
  The serum level of hs-TNI (5.7 ± 9.2 μg/L vs. 3.2 ± 1.9 μg/L, P< 0.01) and the prevalence of elevated hs-TNI (12% vs. 4%, P = 0.02) were significantly higher in patients with T2DM than controls. Patients with T2DM also had significantly worse ba-PWV (17.98 ± 3.91ms-1 vs. 15.70 ± 2.96 ms-1), brachial FMD (2.6 ± 3.5% vs. 5.5 ± 4.2%, P< 0.01) and carotid IMT (0.96 ± 0.20 mm vs. 0.86 ± 0.14 mm, P< 0.01). In patients with T2DM, hs-TNI was positively correlated with systolic blood pressure (r = 0.31, P<0.01), serum creatinine (r = 0.26, P = 0.01) and ba-PWV (r = 0.34, P< 0.01). Importantly, multiple regression revealed that only ba-PWV was independently associated with hs-TNI (β = 0.25, P = 0.04).
  
  
  CONCLUSIONS
  The results demonstrated an independent association between ba-PWV and hs-TNI in patients with T2DM with no clinical evidence of macrovascular disease. These findings suggest that increased arterial stiffness is closely related to subclinical myocardial injury in patients with T2DM.
authors.affiliation: Division of Cardiology, Department of Medicine, the University of Hong Kong, Rm 1929b, Block K, Queen Mary Hospital, China.
authors.forename: Kai-Hang
authors.initials: KH
authors.lastname: Yiu
authors.forename: Chun-Ting
authors.initials: CT
authors.lastname: Zhao
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.forename: Chung-Wah
authors.initials: CW
authors.lastname: Siu
authors.forename: Yap-Hang
authors.initials: YH
authors.lastname: Chan
authors.forename: Kui-Kai
authors.initials: KK
authors.lastname: Lau
authors.forename: Shasha
authors.initials: S
authors.lastname: Liu
authors.forename: Chu-Pak
authors.initials: CP
authors.lastname: Lau
authors.forename: Hung-Fat
authors.initials: HF
authors.lastname: Tse
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000097:blood* / Q000150:complications; D002318:Cardiovascular Diseases / Q000150:complications; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D019210:Troponin I / Q000097:blood*; D059289:Vascular Stiffness; D014664:Vasodilation
chemical_list: D019210:Troponin I